Wiggins Kimberly T, Hall Tristen L, Jortberg Bonnie, Dickinson W Perry, Dickinson L Miriam, Parascando Jessica A, Fernald Douglas H, Sobczak Chelsea, Oser Sean M, Oser Tamara K
Department of Family Medicine, University of Colorado Anschutz Medical Campus, Mail Stop F496, 12631 E. 17th Avenue, Aurora, CO, 80045- 0508, USA.
BMC Prim Care. 2025 Jun 9;26(1):195. doi: 10.1186/s12875-025-02903-0.
Most diabetes care occurs in primary care. Continuous glucose monitoring (CGM) is associated with clinical, behavioral, and psychosocial benefits. While CGM uptake in primary care is increasing, understanding models to support CGM use in diverse primary care practices is needed. The PREPARE 4 CGM study evaluated strategies to implement CGM in primary care. We compared characteristics among practices choosing a practice-led, self-paced CGM implementation strategy or referral to a virtual CGM implementation service that provided patients and their referring primary care practices CGM initiation and data interpretation support for at least six months.
Colorado PC practices interested in implementing CGM enrolled and chose to use the American Academy of Family Physicians Transformation in Practice Series (TIPS): CGM implementation modules or refer patients to a virtual CGM initiation and education service designed and staffed by a primary care multi-disciplinary team. In this multiple methods study, baseline practice characteristics were compared across study arms using chi-square and t-tests. Semi-structured interviews with practice members provided additional context to explain study arm selection.
Of 76 practices enrolled, 46 chose self-paced implementation using TIPS modules, 16 of which (35%) had a diabetes care and education specialist (DCES) in the practice; of the 30 that chose the virtual CGM initiation service, none (0%) had a DCES, X(1, N = 62) = 11.046, p <.001. Aside from having a DCES, no differences in 37 other practice characteristics were seen between groups.
Primary care practices were eager to implement CGM. All practices with a DCES chose to implement CGM on their own; of the practices without a DCES, implementation method selection was evenly split (half chose to implement on their own, half chose virCIS). DCESs may have potential as diabetes technology champions in primary care practices. Referral to the virtual CGM implementation service allowed access to a certified DCES and multidisciplinary team for practices without them. As many practices without a DCES also chose to implement CGM on their own, multiple models may be necessary to foster CGM implementation in primary care.
This project was reviewed and approved by the Colorado Multiple Institutional Review Board (COMIRB; Protocol 21-4269) and registered with ClinicalTrials.gov on March 23, 2022 (NCT05336214).
大多数糖尿病护理在初级保健中进行。持续葡萄糖监测（CGM）与临床、行为和心理社会益处相关。虽然初级保健中CGM的采用率在增加，但需要了解支持在不同初级保健实践中使用CGM的模式。PREPARE 4 CGM研究评估了在初级保健中实施CGM的策略。我们比较了选择以实践为主导、自定进度的CGM实施策略或转介至虚拟CGM实施服务的实践之间的特征，该虚拟服务为患者及其转诊的初级保健实践提供至少六个月的CGM启动和数据解读支持。
对有兴趣实施CGM的科罗拉多初级保健实践进行招募，并选择使用美国家庭医生学会实践转型系列（TIPS）：CGM实施模块，或把患者转介至由初级保健多学科团队设计并配备人员的虚拟CGM启动和教育服务。在这项多方法研究中，使用卡方检验和t检验比较各研究组的基线实践特征。对实践成员进行的半结构化访谈提供了更多背景信息，以解释研究组的选择。
在登记的76个实践中，46个选择使用TIPS模块进行自定进度的实施，其中16个（35%）实践中有糖尿病护理和教育专家（DCES）；在选择虚拟CGM启动服务的30个实践中，没有一个（0%）有DCES，X(1, N = 62) = 11.046，p <.001。除了有DCES外，两组之间在其他37个实践特征上没有差异。
初级保健实践渴望实施CGM。所有有DCES的实践都选择自行实施CGM；在没有DCES的实践中，实施方法的选择平均分配（一半选择自行实施，一半选择虚拟CGM启动和教育服务）。DCES在初级保健实践中可能有潜力成为糖尿病技术的倡导者。将实践转介至虚拟CGM实施服务，使没有DCES的实践能够获得认证的DCES和多学科团队的支持。由于许多没有DCES的实践也选择自行实施CGM，可能需要多种模式来促进初级保健中CGM的实施。
本项目经科罗拉多多机构审查委员会（COMIRB；协议21 - 4269）审查并批准，并于2022年3月23日在ClinicalTrials.gov注册（NCT05336214）。
